should I supplement small baby with formula?

[Corilee2806]

Hi,

Looking for a bit of advice or experiences of others who’ve gone through similar.

My 4.5 month old DD is very small -born weighing 5lb at 37 weeks - we knew she was small (SGA) from growth scans from about 33 weeks.

She’s now just over 9lb so very small for her age but has gained consistently after an initial loss of around 10% - so she has always been little but is growing along her line and has pretty much doubled her birth weight. She is BF and we give her a bottle of formula at night which seems to be working ok, but I’m looking at options to boost her weight gain. I express every night at the same time she gets her bottle so I can give her this as a top up occasionally but I never get much out of the pump - a few ozs max. I struggle to fit pumping sessions throughout the day as she still feeds quite often or is napping on me!

If I introduce more formula top ups after feeds, will this help and will it affect BF? After a difficult start with it I am really keen to keep it up but would just like to see her gaining more weight. If there’s a way to successfully combine feed I would love to do it but I know that introducing more formula often affects breast milk supply.

Just to note - she is satisfied after and between feeds, she’s a happy and content girl meeting all her milestones and I’ve had her checked regularly by GP, HVs etc. No one is too concerned and they think she is just petite (we are taking her to paediatrician next month just to check and reassure there’s nothing underlying). It won’t be long before I introduce solids which I hope will help but it’s just what I can do on the meantime to help her gain weight. She just seems so little compared to other babies and I can’t help but worry!

[InDubiousBattle]

If the hv and gp aren't concerned the I don't think you need to be, it sounds like she's doing well. I wouldn't bother complicating things or risk bf by topping up when it seems unnecessary.

[INeedNewShoes]

My milk supply always required a lot of effort. Giving DD formula would have meant that my milk supply would decrease (baby will feed less from you so you will make less).

If she is gaining according to her percentile line, isn't dropping off the chart and is happy and alert then you're probably fine as you are!

I was expressing 8 times a day in the first few weeks to boost my supply then dropped to 4 times by 3 months but I have to say it was only when I stopped expressing altogether that we got into a natural rhythm with my supply being good enough to meet DD's demand.

I would have DD feeding from you overnight as that is when the hormone is at its peak that boosts supply. The pump won't send the message to your supply as effectively as DD will. The magic timeframe I think is between 1am and 5am so you ideally want to be feeding a hungry baby during that time to boost supply.

I found expressing time consuming and soul destroying. If you can have the confidence to drop it my hunch is it'll all get easier.

[LiliesAndChocolate]

Don't.
You could jeopardise your milk supply.

If she is growing following her line, it is perfectly fine. Do not overfeed her or get her in the habit of eating when not hungry.
Unless there is a medical concern or a decline in the growth, stick with the breast.
Wait for your paediatrician appointment and listen to their recommendations.

[Corilee2806]

Thanks all for your advice. That’s what I worry about with formula - I suspect she is a ‘little and often’ feeder so if I start messing it up by filling it up with formula I think it could impact my supply.

I will definitely take advice from the paediatrician and am really glad she’s been referred, just want to do as much as I can in the meantime. It’s hard not to worry about whether you’re doing the best or right thing. I know BF is giving her the best start but at the same time I’m worrying that she could be growing faster, but hopefully she’ll catch up to where she’s meant to be eventually.

[Corilee2806]

Also to say I found the same with expressing - when I was doing it more regularly all I found was that DD wasnt able to get enough of when she fed if I had expressed too recently - cue meltdown and then giving her what I had pumped which defeats the purpose really! It didn’t seem to boost my supply at all.

[stucknoue]

Unless you have medical advice don't worry, some babies are smaller, they catch up don't worry!

[BertrandRussell]

If she’s gaining steadily and meeting her milestones and peeing and pooing and nobody (but you ) is worried, then I wouldn’t risk upsetting what’s working. She’s just little!

[MigGril]

Ok don't think about her actual size, look at these she is growing along her growth line. Great this is just what she should be doing.
She had doubled her birth weight in 4.5 months great again really good sign.
She is happy content and meeting all her mile stones. Brilliant sounds like your doing a great job. She's just smaller then average which some babies have to be or there wouldn't be a middle line.

Introducing more formula now will just compromise your milk supply. When it sounds like your actually doing really well.

How much you can pump is never an indication of supply and many mum's feed fine without being able to pump at all. Breast milk changes in cositancy over time so the volume of milk a baby takes in doesn't change. Milk produced by a mum for a 1 year old is very different from a 1 month old. Which is why milk banks can only take donations from mum's for a certain time period. Where as formula doesn't change so you need to increase the amount you give.

Note food won't always make a difference and some small children can be slow to wean, this isn't a bad thing milk has a lot of fat in it. More then most foods.

[BertrandRussell]

I can’t stop thinking about how enchanting she must be.........

[Corilee2806]

Thanks all, really reassuring replies. It’s so hard not to second guess yourself! Especially when people comment on her size all the time...

BertrandRussell - I think so but I am rather biased! She confuses people as they think she is still really new due to her size, then she gives them a smile that lights up her whole face!

[BertrandRussell]

That sound you can hear? It’s my heart melting......

[SnuggyBuggy]

Some babies are big and some are small, it's not a competition. If you aren't being advised to top up I wouldn't.

[Corilee2806]

Thanks - I never said it was a competition. Having a baby well below the 0.4 percentile is just a bit concerning and it’s hard not to worry and doubt myself - realise that some babies have to be the smallest but I just want to make sure I’m doing the best for her.

[BertrandRussell]

“I just want to make sure I’m doing the best for her.“
You are! She sounds fabulous! It sounds ridiculous-and setting all health considerations aside- I really wanted a dinky baby. Mine were enormous- and I worried about them being too heavy! They are both perfectly ordinary sized young adults now. Of course.

[INeedNewShoes]

OP I don't think you should doubt that you're doing the best for her.

My DD spent her first year not quite managing to cling onto the 2nd percentile line despite being on the 25th at birth. Because of that drop the midwives and HV were concerned. However she steadily gained weight albeit very slowly and was clearly a happy healthy baby. My GP kept telling me to stop worrying about her weight but it took me a long time to feel more confident.

DD has moved up a percentile line now but is still a skinny little thing despite eating far more than her peers. I think she just is a busy baby with a fast metabolism and always was from day 1.

I wish I could rewind and not worry so much in those first few months.

If the medics are happy with everything please try to let the weight worries go a bit.

[Corilee2806]

Hi, returning to this thread as we’ve now seen the paediatrician and I feel more confused than ever. She wasn’t too concerned by DDs weight and her overall assessment was that she’s just a little girl - no tests or anything needed at this point. However, she’s still not on the centile chart at 5.5 months (for weight - her length is fairly average) and she recommended introducing 2 more bottles a day so giving 3 bottles of formula in total and BF the rest of the time. She also suggested starting to introduce solids. This surprised me a bit as surely at this age she’ll be taking tiny amounts which won’t help with weight gain? However I guess in time it might if she takes to it well. She is 6 months in 2 weeks and can sit up in a highchair so I’m happy to start giving it a go - albeit going very slowly.

I’m just not sure about the overall advice. I guess at nearly 6 months i feel more ok to slowly phase out BF (I did really want to do at least 6) as I know introducing more bottles will potentially affect my supply which I suspect has never been great - as much as DD gains weight she needs to feed very frequently and I’m pretty exhausted from it - but she’s only gaining a few ozs a week. I think my priority now is to help boost her weight so don’t want to try and keep BF at all costs, but will miss it so much (plus it’s the main way I get her to sleep!) I just feel a bit sad and confused really, I’ve never had much confidence in feeding her as it’s been pretty tough from the start.

[MustardScreams]

You’ve done amazingly! Don’t ever feel a moment of guilt, you’ve given your daughter a fab start in life with breast milk. You can give formula and continue with breastfeeding for naps and sleep and see how you get on?

In regards to weaning if she’s almost 6 months I’d go for it. Don’t replace any milk feeds with food, and remember food is for fun under 1. Babies tend to not eat much at all for ages, so don’t panic! Dd didn’t eat 3 meals until she was 18 months. She’s a fellow tiny baby and tiny toddler. It does mean she’s easy to pick up when having a full blown tantrum though

[Corilee2806]

Yes I think I need to work out what time of day I introduce the bottles so I can still BF for naps. Think I’m going to have to get more organised!

I think I will start her on solids and just take it slowly and be led by her. She’s definitely very interested in food!

[Corilee2806]

And good selling point for having a tiny baby/toddler - will remember that for future reference!

[Merename]

I can understand why you are confused. If it were me, I’d be happy to start slowly on solids like you say, but I’d be more dubious about the formula. From what you have said, she is giving you no indication that she wants extra milk, so is the paed saying that the formula will help by having more calories than breast milk? As I assume if she’s not going hungry at the moment, the extra bottles will just make her breastfeed less and each contain similar calories I believe. Formula just takes longer to digest.

I think you are (understandably but unnecessarily) taking too much responsibility for this. It is not likely all about your supply - also her appetite, as the two go hand in hand. I take it any anatomical difficulty for DD in transferring milk has been ruled out?

[SnuggyBuggy]

I'd be tempted to get an opinion from a breastfeeding counselor as well

[Corilee2806]

Yes I think that’s what the paediatrician was suggesting - I think all that would happen is that she would go slightly longer between feeds and she said it would allow my supply to build up more. She has been very demanding in the last month or so which has made me wonder if I am making enough for her - but she’s always been a little and often feeder. I’ve worked with a breastfeeding consultant before who helped in the early days when my supply was an issue and she was brilliant so think I will get in touch with her again. She’s been checked for tongue tie and there were issues with latch to begin with but this was corrected- not sure if there’s anything else that could be looked at?

[Merename]

Well it’s certainly not the case that adding in formula would allow your supply to build up - I think a helpful phrase is breastfeeding is a ‘take and make’ arrangement. Your body will make only what is being taken, and it is likely that less bm will be taken if she’s filling up on formula. The only way to build supply really is more feeding, or expressing- feeding superior though. You can ‘switch nurse’ if she seems still hungry and you feel empty - returning to the first breast after the second and repeat, this helps supply too.

A breastfeeding consultant would be great, definitely worth a go before you make changes. Tongue ties can grow back, and things like the shape of baby’s palate can play a part. Although your DD is probably too big to consider any further revision even if it had regrown.